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Medial Knee Injury: Part 2, Load Sharing Between the Posterior Oblique Ligament and Superficial Medial Collateral Ligament
American Journal of Sports Medicine, 09/14/09

Wijdicks CA et al. – This study found alterations in the native load–sharing relationships of the medial knee structures after injury. Sectioning both the primary and secondary restraints to valgus and internal/external rotation of the knee alters the intricate load–sharing relationships that exist between the medial knee structures.

Exclusive Author Commentary
Robert F. LaPrade, 09/16/09

We believe that the results presented in this study provide clinically valuable information in regards to the load distribution of the primary medial knee structures. This study examined the compensatory load-sharing characteristics of the posterior oblique ligament and the two divisions of the superficial medial collateral ligament following sequential sectioning of the posterior oblique ligament, the proximal and distal divisions of the superficial medial collateral ligament, and the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament. Our results demonstrated that medial knee injuries alter the intricate load sharing relationships that exist between all of the medial knee structures, which, if left untreated, could potentially increase the risk for further injury. Specifically, for the forces seen on the posterior oblique ligament, we found a significant increase in valgus load compared to the intact state after sectioning the components of both the deep and superficial medial collateral ligaments at 0°, 20°, and 30° of knee flexion. This observation correlates both with a previous article which demonstrated that the posterior oblique ligament experiences tensile load to valgus forces in intact knees especially close to knee extension, and with the previous literature which reported the posterior oblique ligament has a secondary stabilization role in valgus stability of the knee. Therefore, it is logical that the posterior oblique ligament would demonstrate an increased load response in superficial and deep medial collateral ligament deficient knees. Therefore, consideration should be given to repairing or reconstructing all injured medial knee structures to restore the normal load sharing relationships among these structures at the time of surgical treatment. Robert F. LaPrade, MD, PhD Coen A. Wijdicks, MSc University of Minnesota Department of Orthopaedic Surgery Minneapolis, Minnesota

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